Coordinated insulin-meal administration lowers glycaemic fluctuation in hospitalized T2D patients

A coordinated timing from insulin administration to meal consumption (insulin-meal) results in decreased glycaemic fluctuation among hospitalized patients with type 2 diabetes (T2D), results of a recent study have shown.

The investigators sought to examine the impact of coordinated versus mismatched insulin-meal administration on glycaemic fluctuation and outcomes among hospitalized T2D patients. Eligible participants were those who received at least one dose of insulin as part of sliding scale regimen. The investigators then obtained data such as capillary blood glucose values and insulin-meal time intervals.

Overall, 215 patients with 840 insulin-meal encounters were included in this study. Of the participants, 206 belonged to the insulin-meal mismatch group and nine to the coordinated insulin-meal administration group.

Mean glycaemic fluctuation was lower in the coordinated insulin-meal administration group compared to the insulin-meal mismatch group (5.6 vs 6.5 mmol/L or 100 vs 117 mg/dL). Encounters with the insulin-meal time interval of 30–45 min (n=172) correlated with the lowest percentage of severe hyperglycaemia occurrences (13 percent) as compared to encounters with time interval of 0–29 min (n=280; 15 percent) and >45 min (n=246; 16 percent).

In a separate opinion, Etie Moghissi from the University of California stressed the importance of frequent and effective glucose monitoring to avoid wide deviations from acceptable glucose levels, “which under a recently promulgated consensus guideline currently range between 140 and 180 mg/dL.” For hospitalized patients, the recommended glucose target is near 140 mg/dL. [Curr Med Res Opin 2010;26:589-598]